Infrastructure Considerations for Successful Implementation of Bispecific Therapies in Community Practices

The successful implementation of bispecific antibodies requires comprehensive infrastructure planning that addresses both clinical protocols and staff education across multiple departments. Emergency response pathways must be clearly defined, including protocols for after-hours fever management, clear communication channels for on-call physicians, and prearranged relationships with emergency departments or direct admission processes. Infusion centers need adequate space and staffing to manage potential tocilizumab administration during business hours, while pharmacy services require familiarity with drug preparation and storage requirements for these specialized therapies.

The interpretation of product labeling regarding hospitalization requirements has evolved with clinical experience, with many centers focusing on ensuring appropriate monitoring and safety measures rather than strict inpatient management. Step-up dosing intervals can be optimized to minimize hospitalization duration while maintaining safety, with most programs using 48-hour intervals between doses when possible. The development of standardized order sets and clear algorithms for cytokine release syndrome management helps ensure consistent care delivery regardless of which physician is covering patient care during treatment periods.

Training and education extend beyond hematology staff to include emergency medicine physicians, hospitalists, and infusion nurses who may encounter patients experiencing complications. The creation of simple, standardized protocols for cytokine release syndrome management—similar to infusion reaction protocols used for monoclonal antibodies—helps ensure appropriate care across different specialties. As the number of approved bispecific antibodies continues to grow across multiple hematologic and solid tumor indications, these infrastructure investments will become increasingly valuable for practices serving patients with various cancer types requiring T-cell redirection therapies.